Factors operating not only in adult life, but also from conception, have impact on lifelong cardiovascular health. Animal and human studies, including our own, are now providing intriguing clues into the pre- and perinatal determinants of childhood obesity and cardiovascular risk. But prospective data are lacking, and translation into preventive interventions has only just begun. With the support from this K24 competing continuation grant, Dr. Gillman and his mentees will focus intensively on this area of research for the next five years, a critical period not only for the field itself, but also for continuing to expand his potential for significant contributions and for nurturing the next generation of patient-oriented researchers in this field. The specific aims of this proposal are (1) To examine pre- and perinatal determinants of childhood obesity and cardiovascular risk factors. These analyses will take advantage of the infrastructure provided by the ongoing NIH-funded Project Viva, a prospective cohort study of pregnant women and their children. (2) To provide a nourishing professional environment for the training and advancement of beginning clinical researchers, who will conduct studies within Project Viva and other ongoing patient-oriented research projects in the area of the life course approach to chronic disease. Major foci will be in the areas of (1) pre- and perinatal origins of obesity, cardiovascular risk, asthma, and cognition; (2) determinants of diet and physical activity in adolescence; and (3) innovative interventions to prevent obesity in young children.